NR 548 Psychiatric Assessment for the Psychiatric-
Mental Health Nurse Practitioner | Chamberlain
University NR548 Study Guide & Exam Prep
2026/2027 | PMHNP Psychiatric Assessment
Review, Psychiatric Interview, Mental Status
Examination, Differential Assessment, DSM-5-TR
Diagnostic Concepts, Therapeutic Alliance, Risk
Assessment, Suicide Assessment, Substance Use
Assessment, Psychosocial History, Cultural
Assessment, Clinical Reasoning, Practice Questions,
Answers & Detailed Rationales
Question 1: A 72-year-old male patient with a history of hypertension and type
2 diabetes presents with a two-month history of progressive memory loss,
difficulty finding words, and episodes of confusion that are worse in the
evenings. His family reports he has become increasingly apathetic and has
poor judgment, such as wearing a heavy coat on a hot day. Which specific
cognitive domain is MOST significantly impaired based on the symptom of
wearing a heavy coat in warm weather?
A. Memory
B. Executive Function
C. Language
D. Visuospatial Skills
CORRECT ANSWER: B. Executive Function
Rationale: Executive function encompasses higher-order cognitive processes, including
judgment, planning, and insight. Wearing a heavy coat in hot weather demonstrates a
profound deficit in judgment and reasoning, which are core components of executive
function. This finding is a classic indicator of frontal lobe or frontotemporal pathway
dysfunction, often seen in conditions like frontotemporal dementia or advanced
Alzheimer's disease. While memory, language, and visuospatial skills may also be
impaired, the specific symptom described is a hallmark of executive dysfunction.
Question 2: During a psychiatric interview, a 45-year-old woman reports
significant difficulty falling asleep and staying asleep, which has persisted for
the last six months. She endorses frequent, intrusive worries about her job
performance, her children's safety, and her own health. She describes feeling
"on edge" and has muscle tension in her neck and shoulders. Her symptoms
cause clinically significant distress and impairment in her occupational
functioning. Which of the following is the MOST appropriate screening tool to
both establish the severity of her symptoms and monitor her response to
treatment over time?
,A. Hamilton Anxiety Rating Scale (HAM-A)
B. Generalized Anxiety Disorder 7-item scale (GAD-7)
C. Beck Anxiety Inventory (BAI)
D. Zung Self-Rating Anxiety Scale (SAS)
CORRECT ANSWER: A. Hamilton Anxiety Rating Scale (HAM-A)
Rationale: The HAM-A is a clinician-administered scale that is widely used to assess the
severity of anxiety symptoms in patients with generalized anxiety disorder and other
anxiety disorders. It is particularly useful for monitoring treatment response over time.
The GAD-7 is a brief, self-reported screening tool, but it is more suited for screening
rather than detailed severity assessment and monitoring. The BAI focuses more on
somatic symptoms and differentiates anxiety from depression, but the HAM-A is
considered the gold standard for severity and treatment response monitoring in clinical
trials and practice.
Question 3: A 28-year-old patient with a recent diagnosis of bipolar I disorder
is started on lithium carbonate. Prior to initiating therapy, which of the
following baseline assessments is the MOST critical to obtain to ensure patient
safety and guide dosing?
A. Complete blood count (CBC) and platelet count
B. Thyroid-stimulating hormone (TSH) and serum creatinine
C. Electrocardiogram (ECG) and fasting lipid panel
D. Liver function tests (ALT, AST) and serum glucose
CORRECT ANSWER: B. Thyroid-stimulating hormone (TSH) and serum
creatinine
Rationale: Lithium has a narrow therapeutic index and can cause significant toxicity.
Before starting lithium, it is essential to assess renal function (serum creatinine) to
establish a baseline for safe dosing, as lithium is exclusively excreted by the kidneys.
Additionally, lithium is known to affect thyroid function, frequently causing
hypothyroidism; thus, a baseline TSH is necessary to monitor for subsequent changes.
While other tests like ECG (for age or cardiac history), CBC, and LFTs may be indicated
in specific circumstances, baseline renal and thyroid function are universally required.
Question 4: A psychiatric-mental health nurse practitioner is conducting a
follow-up visit with a patient who has been taking fluoxetine 40 mg daily for
10 weeks for major depressive disorder. The patient reports a 50%
improvement in mood and sleep but continues to experience low energy and
poor concentration. Which of the following is the MOST appropriate
pharmacologic intervention?
A. Discontinue fluoxetine and start bupropion
B. Increase the dose of fluoxetine to 60 mg daily
C. Add a low dose of aripiprazole to the fluoxetine
D. Add a low dose of bupropion to the fluoxetine
,CORRECT ANSWER: D. Add a low dose of bupropion to the fluoxetine
Rationale: This patient has had a partial response to an SSRI (fluoxetine) but continues
to have residual symptoms of fatigue and poor concentration. Adding bupropion, a
norepinephrine-dopamine reuptake inhibitor (NDRI), is a common and evidence-based
augmentation strategy to target these specific residual symptoms. It can provide an
activating effect and improve energy and focus. Increasing the fluoxetine dose might be
an option, but the patient has already had a 50% response, and augmentation is often
preferred to avoid higher SSRI doses' side effects. Switching to bupropion monotherapy
is an option, but augmentation is a more conservative and effective first step.
Question 5: A 16-year-old female is brought to the clinic by her mother due to
a significant decline in school performance and social withdrawal over the past
8 months. The patient reports feeling sad most of the day, has a poor appetite
with a 10-pound weight loss, and has difficulty sleeping. She also reports
persistent feelings of worthlessness and recurrent thoughts of death. The
PMHNP assesses the patient and considers a diagnosis of major depressive
disorder. According to the DSM-5-TR criteria, which specifier is MOST
appropriate for this patient if she has a history of manic episodes?
A. With anxious distress
B. With melancholic features
C. With psychotic features
D. With mixed features
CORRECT ANSWER: D. With mixed features
Rationale: The "with mixed features" specifier is used when a patient meets the full
criteria for a major depressive episode but also has at least three symptoms of a
(hypo)manic episode that are not part of the depressive episode criteria. A history of
manic episodes itself does not automatically confer a specifier; it indicates a bipolar
disorder diagnosis. However, if the current episode includes mixed features (e.g.,
elevated mood, grandiosity, increased goal-directed activity) alongside depressive
symptoms, this specifier would be applied to the current depressive episode. If the
patient has a history of manic episodes, the diagnosis is bipolar I disorder, current
episode depressed, with mixed features if the criteria are met.
Question 6: A 55-year-old patient with a 30-year history of alcohol use
disorder is admitted for detoxification. He reports drinking a fifth of vodka
daily. Six hours after his last drink, he becomes diaphoretic, tremulous, and
tachycardic. His blood pressure is 150/95 mmHg. Which of the following
medications is the FIRST-LINE treatment to prevent the progression of
withdrawal symptoms and the development of delirium tremens?
A. Haloperidol
B. Lorazepam
C. Carbamazepine
D. Clonidine
, CORRECT ANSWER: B. Lorazepam
Rationale: Benzodiazepines are the mainstay of treatment for alcohol withdrawal and are
the first-line agents for preventing the progression of withdrawal symptoms to more
severe states like seizures and delirium tremens. They work by enhancing GABAergic
neurotransmission, which counteracts the central nervous system hyperexcitability
caused by the abrupt cessation of alcohol. Lorazepam is a preferred choice due to its
intermediate duration of action, lack of active metabolites, and safety in patients with
hepatic impairment. While haloperidol may be used for agitation, it does not prevent
seizures or delirium tremens. Carbamazepine and clonidine are not first-line.
Question 7: A 30-year-old patient presents with a one-year history of
recurrent, unexpected panic attacks. She has developed a persistent fear of
having another attack and has significantly altered her behavior, avoiding
crowded places, public transportation, and open spaces. She feels intense
anxiety when leaving her home alone. Which of the following is the MOST
appropriate diagnosis?
A. Panic Disorder
B. Agoraphobia
C. Social Anxiety Disorder (Social Phobia)
D. Panic Disorder with Agoraphobia
CORRECT ANSWER: D. Panic Disorder with Agoraphobia
Rationale: The diagnosis is Panic Disorder with Agoraphobia. The patient meets the
criteria for panic disorder (recurrent unexpected panic attacks with persistent worry
about further attacks). In addition, she demonstrates the hallmark features of
agoraphobia, which include marked fear or anxiety about two or more situations (e.g.,
using public transportation, being in open or enclosed spaces, standing in line or being
in a crowd, or being outside of the home alone) that is triggered by fears of escaping or
not getting help if a panic attack occurs. The presence of both criteria warrants this
combined diagnosis.
Question 8: When assessing a patient for post-traumatic stress disorder
(PTSD), the PMHNP asks about the "B" criteria. Which of the following
symptoms is representative of the B criterion (Intrusion) in the DSM-5-TR?
A. Avoidance of internal or external reminders of the traumatic event
B. Negative alterations in cognitions and mood, such as persistent negative beliefs about
oneself
C. Recurrent, involuntary, and intrusive distressing memories of the traumatic event
D. Marked alterations in arousal and reactivity, such as hypervigilance
CORRECT ANSWER: C. Recurrent, involuntary, and intrusive distressing
memories of the traumatic event
Rationale: The DSM-5-TR diagnostic criteria for PTSD are divided into several clusters.
The B criterion specifically refers to Intrusion symptoms. This includes recurrent,
Mental Health Nurse Practitioner | Chamberlain
University NR548 Study Guide & Exam Prep
2026/2027 | PMHNP Psychiatric Assessment
Review, Psychiatric Interview, Mental Status
Examination, Differential Assessment, DSM-5-TR
Diagnostic Concepts, Therapeutic Alliance, Risk
Assessment, Suicide Assessment, Substance Use
Assessment, Psychosocial History, Cultural
Assessment, Clinical Reasoning, Practice Questions,
Answers & Detailed Rationales
Question 1: A 72-year-old male patient with a history of hypertension and type
2 diabetes presents with a two-month history of progressive memory loss,
difficulty finding words, and episodes of confusion that are worse in the
evenings. His family reports he has become increasingly apathetic and has
poor judgment, such as wearing a heavy coat on a hot day. Which specific
cognitive domain is MOST significantly impaired based on the symptom of
wearing a heavy coat in warm weather?
A. Memory
B. Executive Function
C. Language
D. Visuospatial Skills
CORRECT ANSWER: B. Executive Function
Rationale: Executive function encompasses higher-order cognitive processes, including
judgment, planning, and insight. Wearing a heavy coat in hot weather demonstrates a
profound deficit in judgment and reasoning, which are core components of executive
function. This finding is a classic indicator of frontal lobe or frontotemporal pathway
dysfunction, often seen in conditions like frontotemporal dementia or advanced
Alzheimer's disease. While memory, language, and visuospatial skills may also be
impaired, the specific symptom described is a hallmark of executive dysfunction.
Question 2: During a psychiatric interview, a 45-year-old woman reports
significant difficulty falling asleep and staying asleep, which has persisted for
the last six months. She endorses frequent, intrusive worries about her job
performance, her children's safety, and her own health. She describes feeling
"on edge" and has muscle tension in her neck and shoulders. Her symptoms
cause clinically significant distress and impairment in her occupational
functioning. Which of the following is the MOST appropriate screening tool to
both establish the severity of her symptoms and monitor her response to
treatment over time?
,A. Hamilton Anxiety Rating Scale (HAM-A)
B. Generalized Anxiety Disorder 7-item scale (GAD-7)
C. Beck Anxiety Inventory (BAI)
D. Zung Self-Rating Anxiety Scale (SAS)
CORRECT ANSWER: A. Hamilton Anxiety Rating Scale (HAM-A)
Rationale: The HAM-A is a clinician-administered scale that is widely used to assess the
severity of anxiety symptoms in patients with generalized anxiety disorder and other
anxiety disorders. It is particularly useful for monitoring treatment response over time.
The GAD-7 is a brief, self-reported screening tool, but it is more suited for screening
rather than detailed severity assessment and monitoring. The BAI focuses more on
somatic symptoms and differentiates anxiety from depression, but the HAM-A is
considered the gold standard for severity and treatment response monitoring in clinical
trials and practice.
Question 3: A 28-year-old patient with a recent diagnosis of bipolar I disorder
is started on lithium carbonate. Prior to initiating therapy, which of the
following baseline assessments is the MOST critical to obtain to ensure patient
safety and guide dosing?
A. Complete blood count (CBC) and platelet count
B. Thyroid-stimulating hormone (TSH) and serum creatinine
C. Electrocardiogram (ECG) and fasting lipid panel
D. Liver function tests (ALT, AST) and serum glucose
CORRECT ANSWER: B. Thyroid-stimulating hormone (TSH) and serum
creatinine
Rationale: Lithium has a narrow therapeutic index and can cause significant toxicity.
Before starting lithium, it is essential to assess renal function (serum creatinine) to
establish a baseline for safe dosing, as lithium is exclusively excreted by the kidneys.
Additionally, lithium is known to affect thyroid function, frequently causing
hypothyroidism; thus, a baseline TSH is necessary to monitor for subsequent changes.
While other tests like ECG (for age or cardiac history), CBC, and LFTs may be indicated
in specific circumstances, baseline renal and thyroid function are universally required.
Question 4: A psychiatric-mental health nurse practitioner is conducting a
follow-up visit with a patient who has been taking fluoxetine 40 mg daily for
10 weeks for major depressive disorder. The patient reports a 50%
improvement in mood and sleep but continues to experience low energy and
poor concentration. Which of the following is the MOST appropriate
pharmacologic intervention?
A. Discontinue fluoxetine and start bupropion
B. Increase the dose of fluoxetine to 60 mg daily
C. Add a low dose of aripiprazole to the fluoxetine
D. Add a low dose of bupropion to the fluoxetine
,CORRECT ANSWER: D. Add a low dose of bupropion to the fluoxetine
Rationale: This patient has had a partial response to an SSRI (fluoxetine) but continues
to have residual symptoms of fatigue and poor concentration. Adding bupropion, a
norepinephrine-dopamine reuptake inhibitor (NDRI), is a common and evidence-based
augmentation strategy to target these specific residual symptoms. It can provide an
activating effect and improve energy and focus. Increasing the fluoxetine dose might be
an option, but the patient has already had a 50% response, and augmentation is often
preferred to avoid higher SSRI doses' side effects. Switching to bupropion monotherapy
is an option, but augmentation is a more conservative and effective first step.
Question 5: A 16-year-old female is brought to the clinic by her mother due to
a significant decline in school performance and social withdrawal over the past
8 months. The patient reports feeling sad most of the day, has a poor appetite
with a 10-pound weight loss, and has difficulty sleeping. She also reports
persistent feelings of worthlessness and recurrent thoughts of death. The
PMHNP assesses the patient and considers a diagnosis of major depressive
disorder. According to the DSM-5-TR criteria, which specifier is MOST
appropriate for this patient if she has a history of manic episodes?
A. With anxious distress
B. With melancholic features
C. With psychotic features
D. With mixed features
CORRECT ANSWER: D. With mixed features
Rationale: The "with mixed features" specifier is used when a patient meets the full
criteria for a major depressive episode but also has at least three symptoms of a
(hypo)manic episode that are not part of the depressive episode criteria. A history of
manic episodes itself does not automatically confer a specifier; it indicates a bipolar
disorder diagnosis. However, if the current episode includes mixed features (e.g.,
elevated mood, grandiosity, increased goal-directed activity) alongside depressive
symptoms, this specifier would be applied to the current depressive episode. If the
patient has a history of manic episodes, the diagnosis is bipolar I disorder, current
episode depressed, with mixed features if the criteria are met.
Question 6: A 55-year-old patient with a 30-year history of alcohol use
disorder is admitted for detoxification. He reports drinking a fifth of vodka
daily. Six hours after his last drink, he becomes diaphoretic, tremulous, and
tachycardic. His blood pressure is 150/95 mmHg. Which of the following
medications is the FIRST-LINE treatment to prevent the progression of
withdrawal symptoms and the development of delirium tremens?
A. Haloperidol
B. Lorazepam
C. Carbamazepine
D. Clonidine
, CORRECT ANSWER: B. Lorazepam
Rationale: Benzodiazepines are the mainstay of treatment for alcohol withdrawal and are
the first-line agents for preventing the progression of withdrawal symptoms to more
severe states like seizures and delirium tremens. They work by enhancing GABAergic
neurotransmission, which counteracts the central nervous system hyperexcitability
caused by the abrupt cessation of alcohol. Lorazepam is a preferred choice due to its
intermediate duration of action, lack of active metabolites, and safety in patients with
hepatic impairment. While haloperidol may be used for agitation, it does not prevent
seizures or delirium tremens. Carbamazepine and clonidine are not first-line.
Question 7: A 30-year-old patient presents with a one-year history of
recurrent, unexpected panic attacks. She has developed a persistent fear of
having another attack and has significantly altered her behavior, avoiding
crowded places, public transportation, and open spaces. She feels intense
anxiety when leaving her home alone. Which of the following is the MOST
appropriate diagnosis?
A. Panic Disorder
B. Agoraphobia
C. Social Anxiety Disorder (Social Phobia)
D. Panic Disorder with Agoraphobia
CORRECT ANSWER: D. Panic Disorder with Agoraphobia
Rationale: The diagnosis is Panic Disorder with Agoraphobia. The patient meets the
criteria for panic disorder (recurrent unexpected panic attacks with persistent worry
about further attacks). In addition, she demonstrates the hallmark features of
agoraphobia, which include marked fear or anxiety about two or more situations (e.g.,
using public transportation, being in open or enclosed spaces, standing in line or being
in a crowd, or being outside of the home alone) that is triggered by fears of escaping or
not getting help if a panic attack occurs. The presence of both criteria warrants this
combined diagnosis.
Question 8: When assessing a patient for post-traumatic stress disorder
(PTSD), the PMHNP asks about the "B" criteria. Which of the following
symptoms is representative of the B criterion (Intrusion) in the DSM-5-TR?
A. Avoidance of internal or external reminders of the traumatic event
B. Negative alterations in cognitions and mood, such as persistent negative beliefs about
oneself
C. Recurrent, involuntary, and intrusive distressing memories of the traumatic event
D. Marked alterations in arousal and reactivity, such as hypervigilance
CORRECT ANSWER: C. Recurrent, involuntary, and intrusive distressing
memories of the traumatic event
Rationale: The DSM-5-TR diagnostic criteria for PTSD are divided into several clusters.
The B criterion specifically refers to Intrusion symptoms. This includes recurrent,
